Closing a Heart Hole May Help Migraines

Can closing a hole in the heart be an effective treatmentfor migraines?

New research suggests that it may for migraine sufferers with a common heartabnormality known as a patent foramen ovale (PFO).

But a researcher who has studied the issue for almost a decade tells WebMDthat the jury is still out on the treatment.

In the new study, patients with PFOs who had a minimally invasivecatheter-based procedure to close the small hole in their heart hadsignificantly fewer disabling migraines than patients with PFOs who did nothave the procedure.

Migraines and PFO Closure

As many as one in four people have a PFO abnormality, but most never knowit.

Prior to birth, everyone has the small opening, which exists to divert bloodaway from undeveloped lungs. Normally, the hole closes after birth, but in somepeople the closure is not complete.

While not everyone with PFOs has migraines and not everyone with migraineshas PFOs, studies show that migraine sufferers are far more likely to have theheart abnormality than people without migraines.

PFO researcher Peter Wilmshurst, MB, of the UK's Royal Shrewsbury Hospital,tells WebMD that about half of patients with a specific type of migraine knownas migraine with aura have large PFOs or similar openings in their heartscompared to about 5% of the population at large.

Wilmshurst did not participate in the new study, but he was involved in anearlier study that examined PFO closure as a treatment for migraines. Publishedlast year, that study, known as the MIST trial, found no benefit for thetreatment.

The new study included 82 migraine patients who had large PFOs and nohistory of strokes. All the patients also had a type of brain lesion that iscommonly seen in brain scans of patients with migraines.

Fifty-three of the patients had the PFO closure procedure and 29 didnot.

At six months follow-up, the PFO closure patients showed significantimprovements in both the frequency and severity of their migraineheadaches.

In all, 53% of patients in the PFO closure group reported a disappearance ofdisabling headaches, compared to 7% of the patients who did not have theclosure procedure; 87% in the closure group reported a more than 50% reductionin total headaches, compared to 21% of the patients in the comparisongroup.

The study appears in the Feb. 24 issue of the Journal of the AmericanCollege of Cardiology.

"Only patients in the closure group reported a significant reduction ofmigraine severity, which is crucial for quality of life," study researcherCarlo Vigna, MD, and colleagues write. "In contrast, the number ofdisabling attacks did not change or increased in 41% of controls."

Why Findings May Vary

In an accompanying editorial, Wilmshurst suggests that the placebo effectmay explain why the findings in the latest trial are so different from those inMIST trial.

The 147 MIST participants had no idea which treatment they were getting, butthe 82 patients in the latest study chose the treatment they received.

"It is possible that in patients with migraine the placebo effect froman operative intervention might be much greater than the magnitude of placeboeffects with drug treatments," he writes.

But Wilmshurst tells WebMD that this doesn't explain why early studiesshowed PFO closure to be an effective treatment for migraines. That's becausepatients in these early trials had the procedure for other reasons and had noexpectations that their headaches would improve.

Several devices used for PFO closure are being marketed in the U.S., andWilmshurst says PFO closure is commonly performed in patients with migraineseven though it is considered experimental and the devices have not beenapproved for the treatment of migraines by the FDA.

"Some people would sk if we should really be using this treatment,since we can't say for sure that it works." he says. "I don't reallyknow the answer to that question."